Use of Routine Prospective Functional and Aesthetic Patient Satisfaction Measurements in Secondary Cleft Lip Rhinoplasty

JAMA Facial Plast Surg. 2018 Dec 1;20(6):488-494. doi: 10.1001/jamafacial.2018.0876.


Importance: Patients, governments, health care providers, and insurance companies show an increased interest in health outcomes, especially in centralized medical care, such as cleft lip nose treatment. Transparent outcome reporting requires a thorough methodological design, dedicated prospective data collection process, and, preferably, no interference with the efficacy of daily practice.

Objective: To describe the implementation of an automated and prospective secondary cleft lip rhinoplasty outcome routine.

Design, setting, and participants: A prospective analytic cohort pilot study was conducted among 123 consecutive patients referred for secondary cleft lip rhinoplasty from July 1, 2014, to March 31, 2018, at an academic teaching hospital.

Exposures: Secondary cleft lip rhinoplasty or revision.

Main outcomes and measures: Preoperative and 3- and 12-month postoperative scores on the Nasal Obstruction Symptom Evaluation scale (range 0-100, lower scores indicate better outcome), Utrecht Questionnaire (range 0-100, lower scores indicate better outcome), and visual analog scales (range 0-10: 0, no obstruction; 10, completely blocked nose) were obtained. Data were exported for automated statistical outcome analysis that was supported by graphic output on a customized web-based dashboard.

Results: Of the 123 patients (68 male and 55 female; mean age, 23 years [range, 17-68 years]) included in the outcome routine, 103 patients (57 male and 46 female; mean age, 22 years [range, 17-50 years]) were eligible for surgery. The web-based dashboard provided demographic characteristics, reasons that surgery was not performed or indicated, and real-time, short- and long-term change in functional and aesthetic outcome after secondary cleft lip rhinoplasty. Among 66 patients with sufficient follow-up, mean (SD) Nasal Obstruction Symptom Evaluation sum scores after rhinoplasty improved from 30.8 (27.6), which is comparable to a moderate problem, to 19.2 (22.2), which is comparable to a very mild problem (P < .001), and mean Utrecht Questionnaire sum scores decreased from 13.1 (5.6) to 7.1 (3.3) (P < .001).

Conclusions and relevance: Routine prospective outcome monitoring provides an evidence-based response to the increasing demand for transparency in health care. The web-based dashboard used during patient counseling, selection, and management of expectations has the potential to compare results of secondary cleft lip rhinoplasty between surgeons and institutions provided that the populations share similar characteristics. The administrative interference with a busy daily practice was limited.

Level of evidence: 4.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cleft Lip / surgery*
  • Esthetics*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods*
  • Patient Satisfaction*
  • Pilot Projects
  • Prospective Studies
  • Reoperation
  • Rhinoplasty / methods*